• Contact Information:

  • Anonymous
    Your identity will be withheld, however, we encourage you to provide us with all of your contact information in case we need any follow up information.
  • First Name *
  • Last Name *
  • Company Name
  • Position
  • Primary Phone*
    ( ) -  ( ) - 
    Ex. (000) - (000) - (0000)
  • Alternate Phone
    ( ) -  ( ) - 
    Ex. (000) - (000) - (0000)
  • Email Address *
    An email address is required in case we need to contact you regarding your request.
  • Do you request to be present during the appointment? *
  • My Address:

  • Type Address *
    (Call , if matching address cannot be found)
  • House Number:
  • Street: *
  • Nearest Cross St.
  • State *
  • County *
  • City *
  • Zipcode *
  • Address Requiring Service:

  • House Number:
  • Street:
  • Nearest Cross St.
  • State *
  • County *
  • City *
  • Zipcode *
  • Pets in Yard*
  • Report Mosquito Problem  
  • Request Mosquitofish  
  • Request an Insect ID  
  • Report Standing Water  
  • How did you hear about us? (Check as many as apply)

  •  News story
     Word of mouth
     Radio
     Internet search
     Event (Presentation, booth, etc.)
     Billboard, sign, or poster
     Social media
     Movie theater ad
     Internet ad
     Property tax bill
     Phone book
     District vehicle or employee
     Repeat Customer
     Other

May we place a mosquito trap on your property?

If we find your property suitable for an invasive Aedes mosquito trap, may we have your permission to place one at an inconspicuous site in your front yard? The trap is the size of a gallon bucket, and would be inspected monthly by uniformed District staff.

  •  Yes, I am willing to have a trap in my front yard.
  •  No
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